Introduction The NHS emphasises programme approaches to commissioning (Health Improvement Programmes and National Service Frameworks) but research is limited. I evaluated the Health Care Programme Approach (HCPA) for stroke whose individual elements are: a co-ordinating group; a co-ordinator; a technical document; and agreement of priorities. Methods 1 Four rounds of interviews with managers and clinicians; observation at meetings; analysis of documentary sources. 2 Quantitative indicators of progress measured at two time points. 3 Estimation of the Programme Budget and Transaction Costs from published sources and local data. 4 Interviews with Directors of Public Health from nine comparator districts. Results 1A structured process led to a set of priorities, which were widely accepted across all agencies, allowing the co-ordinating group to focus on facilitating change. This group took two years to reach a stage where it could change services. Most peoples upportedth e approachb ut were not alwaysc lear aboutt he process. 2 The indicators showed improvements in some aspects of care. 3 The programme budget was £IOm, mostly in long-term care (£5.5m) and hospital care (£3m). The transaction costs amounted to 0.25% of the programme budget. Preface 4 All comparator districts reported changes to commissioning and improvements in stroke services, but I found more widespread change in the study district. Discussion The detailed description of process, and use of multiple methods, gives strength to the findings. A collaborative approach has developed across the NHS during the period of this study making the findings highly relevant. There were important lessons for multiagency groups including: the time needed to function effectively; the need for individuals to clarify whether they represent an organisation or their own perspective; the need to review the group remit and the group's routes of communication; and the ability to adapt to changes in national policy while focusing on improving the health of the patients who fall within the programme. Keywords Planning, Purchasing, Commissioning, Stroke Services, Health Care Programme Approach, Evidence-Based, Multiagency Collaboration, Triangulation, Evaluation, Case Study.

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Sponsor:

NHSE Northern and Yorkshire, Research and Development ; Stroke Association